Pain is a Disease
“Pain is not a symptom, pain is a
disease” was the strong message of a two-day conference at the National
Institutes of Health. Pain and Musculoskeletal
Disorders: Translating Scientific Advances into Practice brought together
international experts in a broad range of domains in the pain field. Daniel J.
Clauw, MD, University of Michigan Neurologist and Interstitial Cystitis
Association (ICA) Medical Advisory Board Member was on the planning committee
of this meeting.
With the aim of stimulating
interdisciplinary research and encouraging faster translation of research to
clinical settings, speakers reviewed what we know and don’t know about pain,
with a special focus on the role that neural factors play in affecting
individual pain sensitivity. Talks covered our current understanding of the
science of pain and inflammation, potential advances from animal models and
clinical studies, regulatory realities, pharmacological and non-pharmacological
treatments, and pain in special populations.
Barbara Gordon, ICA Executive Director attended the two-day meeting.
In a thoughtful introduction by Dr. Clauw, who is also a
principle investigator on the NIDDK MAPP study, spoke about the concept of
chronic pain as a disease state. Drawing upon his clinical experience, he
proposed that chronic pain patients may have an increased pain sensitivity “setpoint.” Because the degree of damage or inflammation in
people with chronic pain (like IC) does not correlate with the level of pain,
doctors may not accurately be able to see the degree of pain which patients are
really experiencing. Perhaps this is
because there may be a problem with centralize processing—a sensory
hypersensitivity which not only causes a greater sensitivity to pain but higher
levels of sensitivity to light, noise, and smell. (At the IPPS Meeting in
Chicago, we learned that IC patients are “super tasters.” Perhaps the enhanced taste buds relate
to the hypersensitivity of smell?)
Leslie J. Crofford, MD, Chief
Division of Rheumatology and Women’s Health at the University of Kentucky,
encouraged healthcare providers to recognize the need to treat all of the pain. Dr. Crofford
said she tells doctors, “Eliminate 90% of a patient’s pain and the remaining
10% is 100% of what is left.
Clifford Woolf, MD, PhD from
Harvard University noted the challenge in developing new, effective, and safe
pain medicines. He too wants researchers
and clinicians to look at pain as a disease and not a symptom and with this new
perception, critically assess current approaches for developing new medicines and
create opportunities for more innovation in both the laboratory and clinic.
Sean Mackey, MD, PhD, from the Stanford
University also presented a call to action for functional neuroimaging
techniques in pain, specifically fMRI. Dr.
Mackey called upon researchers to move beyond studies which simply report
changes in brain activity which he dubbed “blobology.” He wants to know if patients might be able to
control their pain by learning how to control their brain activity. He gave a sneak preview of research (not yet
published) that suggests it might be possible for individuals to find pain
relief by controlling brain signals.
Day two ended with a review of the
need for more awareness about the pain treatment needs of special populations
defined as women, seniors, and minorities. We have reported before on the need
for awareness about differences in gender pain response and treatment approaches.
The final speaker, Dr. Carmen R. Green, MD, University of Michigan, highlighted
studies about racial and ethnic differences in pain care including less access
to pain management specialists, disparities in pain care management approaches,
and decreased health due to the inadequacy of pain treatments. Dr. Green summarized the day nicely, noting
that Dr. Clauw had brought the multidisciplinary team together for a wedding
and it was up to the group to ensure a strong marriage by moving the field
forward through strategic collaborations.
Posted December 16, 2010